Child maltreatment could predict a range of negative outcomes in patients with bipolar disorder (BD), according to new King's College London research, which adds to growing evidence on the enduring mental health impact of childhood abuse and neglect.

A meta-analysis of 30 studies found that bipolar patients with a history of childhood maltreatment developed BD more than four years earlier than patients with no history of maltreatment. In addition, they were almost twice as likely to attempt suicide and nearly four times more likely to have a diagnosis of post-traumatic stress disorder (PTSD).

One in every 25 adults will be diagnosed with bipolar disorder at some point in their life. The disorder is characterised by periods or episodes of feeling very low and lethargic (depression) or of feeling very high and overactive (mania). Bipolar disorder carries the highest risk of suicide among affective disorders: up to 15 per cent of people with bipolar disorder die by suicide. However, not all bipolar patients have these particularly severe outcomes, and there is wide variability in clinical presentation.

Therefore, it is important to identify bipolar patients with the greatest clinical need and risk as early as possible, in order to ensure that they receive the most timely and effective interventions to reduce their risk of poor outcomes.

Maltreatment in the form of physical, sexual or emotional abuse, or neglect, affects one in five children under 18 in the UK and is known to be highly prevalent in bipolar patients (up to 60 percent). Maltreatment predicts negative outcomes in depressed patients, but it was previously unclear if information on maltreatment could help identify early those bipolar patients with greater clinical needs and risk.

The study, published today in The Lancet Psychiatry, found that bipolar patients with a history of childhood maltreatment had more severe manic, depressive and psychotic symptoms; higher risk of post-traumatic stress disorder (PTSD), anxiety disorders, and substance and alcohol misuse disorders; earlier onset of symptoms; more frequent manic and depressive episodes; and higher risk of suicide attempt.

Dr Jessica Agnew-Blais, Post-doctoral Researcher from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London and lead author of the study, said: 'These findings lend support to the notion that maltreatment can affect neurobiological processes associated with progression of the disorder.

'Our findings have important implications for clinical practice, as they suggest that a history of childhood maltreatment could be used as an early indicator of high risk for poor outcomes among individuals with bipolar disorder. This information could be valuable for identifying patients with bipolar disorder who may benefit from greater support and treatment.'

Dr Andrea Danese, Senior Lecturer from the IoPPN at King's College London and senior author of the study, said: 'Future research should identify mechanisms that link childhood maltreatment to unfavourable clinical outcomes in BD, which is associated with disability and life-threatening risks.

'We hope this study will point to vulnerabilities that could inform innovative treatment strategies for people with BD, including anti-inflammatory medications or treatments aimed at trauma and anxiety-related symptoms.'

Dr Danese added: 'Further studies are also needed to assess whether childhood maltreatment predicts treatment response among patients with BD, as has been suggested by early research in this area.'

King's College London is one of the top 20 universities in the world (2015/16 QS World University Rankings) and among the oldest in England. King's has more than 26,500 students (of whom nearly 10,400 are graduate students) from some 150 countries worldwide, and nearly 6,900 staff. The university is in the second phase of a £1 billion redevelopment programme which is transforming its estate.

King's has an outstanding reputation for world-class teaching and cutting-edge research. In the 2014 Research Excellence Framework (REF) King's was ranked 6th nationally in the 'power' ranking, which takes into account both the quality and quantity of research activity, and 7th for quality according to Times Higher Education rankings. Eighty-four per cent of research at King's was deemed 'world-leading' or 'internationally excellent' (3* and 4*). The university is in the top seven UK universities for research earnings and has an overall annual income of more than £600 million.

King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar.

King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: http://www.kingshealthpartners.org.

King's fundraising campaign - World questions | King's answers - created to address some of the most pressing challenges facing humanity has reached its £500 million target 18 months ahead of schedule. The university is now aiming to build on this success and raise a further £100 million by the end of 2015, to fund vital research, deliver innovative new treatments and to support scholarships. The campaign's five priority areas are neuroscience and mental health, leadership and society, cancer, global power and children's health. More information about the campaign is available at http://www.kcl.ac.uk/kingsanswers.

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